The credibility of health economic models for health policy decision-making: the case of population screening for abdominal aortic aneurysm

<i>Objectives</i>: To review health economic models of population screening for abdominal aortic aneurysm (AAA) among elderly males and assess their credibility for informing decision-making. <i>Methods</i>: A literature review identified health economic models of ultrasound screening for AAA. For each model focussing on population screening in elderly males, model structure and input parameter values were critically appraised using published good practice guidelines for decision analytic models. <i>Results</i>: Twelve models published between 1989 and 2003 were identified. Converting costs to a common currency and base year, substantial variability in cost-effectiveness results were revealed. Appraisals carried out for the nine models focusing on population screening showed differences in their complexity, with the simpler models generating results most favourable to screening. Eight of the nine models incorporated two or more simplifying structural assumptions favouring screening; uncertainty surrounding these assumptions was not investigated by any model. Quality assessments on a small number of parameters revealed input values varied between models, methods used to identify and incorporate input data were often not described, and few sensitivity analyses were reported. <i>Conclusions</i>: Large variation exists in the cost-effectiveness results generated by AAA screening models. The substantial number of factors potentially contributing to such disparities means that reconciliation of model results is impossible. In addition, poor reporting of methods makes it difficult to identify the most plausible and thus most useful model of those developed

Estimating Lunar Pyroclastic Deposit Depth from Imaging Radar Data: Applications to Lunar Resource Assessment

Lunar pyroclastic deposits represent one of the primary anticipated sources of raw materials for future human settlements. These deposits are fine-grained volcanic debris layers produced by explosive volcanism contemporaneous with the early stage of mare infilling. There are several large regional pyroclastic units on the Moon (for example, the Aristarchus Plateau, Rima Bode, and Sulpicius Gallus formations), and numerous localized examples, which often occur as dark-halo deposits around endogenic craters (such as in the floor of Alphonsus Crater). Several regional pyroclastic deposits were studied with spectral reflectance techniques: the Aristarchus Plateau materials were found to be a relatively homogeneous blanket of iron-rich glasses. One such deposit was sampled at the Apollo 17 landing site, and was found to have ferrous oxide and titanium dioxide contents of 12 percent and 5 percent, respectively. While the areal extent of these deposits is relatively well defined from orbital photographs, their depths have been constrained only by a few studies of partially filled impact craters and by imaging radar data. A model for radar backscatter from mantled units applicable to both 70-cm and 12.6-cm wavelength radar data is presented. Depth estimates from such radar observations may be useful in planning future utilization of lunar pyroclastic deposits

The Symptoms of Varicose Veins: Difficult to Determine and Difficult to Study

ObjectivesTo investigate the activities which may exacerbate symptoms in patients with varicose veins.MethodsQuestionnaires sent to patients before clinics and at least six months later.ResultsBoth questionnaires were returned by 149 of 203 patients (74%) but only 124 contained adequate data for comparison – 55 from patients who had surgical treatment and 69 who had no surgery. At initial presentation, worsening of discomfort attributed to varicose veins was common during (58%) or after (48%) standing and in hot weather (44%), but less when sitting with the feet down (31%), and after (31%) or when walking (19%). Surgery significantly reduced the total number of symptoms reported by patients at follow-up (p<0.02). However, none of the symptoms reported during specific activities was significantly lessened by surgery compared with no treatment – possibly because the attrition of patients during the study resulted in small numbers for analysis.ConclusionsSymptoms are a common indication for treating varicose veins and it is therefore important to be sure that they are due to the veins, rather than other causes. This report highlights traditional and logical questions which may help to identify symptoms caused by varicose veins but illustrates the difficulty of validating them

The effect of different imaging techniques for the visualisation of evidence in court on jury comprehension

Evidence presented within a courtroom should be clear so that the members of the jury can understand it. The presentation of distressing images, such as human remains, can have a negative effect on the jury since photographic images may evoke emotional responses. Therefore, it is important to understand how other visual mediums may improve comprehension, bias, or distress individuals. For this study, 91 individuals were randomly assigned one of three visual evidence formats in a mock courtroom exercise. These included photographs, 3D visualisations, or a 3D-printed model. The results show that the use of 3D imaging improves the juror’s understanding of technical language used within a courtroom, which in turn better informs the juror’s in their decision-making

COMPARISON of DATA AVAILABILITY and QUALITY for PHARMACOECONOMIC ANALYSIS in BRAZIL VERSUS the UNITED STATES and EUROPEAN UNION: the CASES of DIABETES & HYPERTENSION

Axia Bio Consulting, São Paulo, BrazilI3 Innovus, Medford, MA USAUniversidade Federal de São Paulo, São Paulo, BrazilNovartis Biociencias SA, São Paulo, BrazilNovartis Pharma AG, Basel, SwitzerlandUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Alpha-1 antitrypsin protein and gene therapies decrease autoimmunity and delay arthritis development in mouse model

<p>Abstract</p> <p>Background</p> <p>Alpha-1 antitrypsin (AAT) is a multi-functional protein that has anti-inflammatory and tissue protective properties. We previously reported that human AAT (hAAT) gene therapy prevented autoimmune diabetes in non-obese diabetic (NOD) mice and suppressed arthritis development in combination with doxycycline in mice. In the present study we investigated the feasibility of hAAT monotherapy for the treatment of chronic arthritis in collagen-induced arthritis (CIA), a mouse model of rheumatoid arthritis (RA).</p> <p>Methods</p> <p>DBA/1 mice were immunized with bovine type II collagen (bCII) to induce arthritis. These mice were pretreated either with hAAT protein or with recombinant adeno-associated virus vector expressing hAAT (rAAV-hAAT). Control groups received saline injections. Arthritis development was evaluated by prevalence of arthritis and arthritic index. Serum levels of B-cell activating factor of the TNF-α family (BAFF), antibodies against both bovine (bCII) and mouse collagen II (mCII) were tested by ELISA.</p> <p>Results</p> <p>Human AAT protein therapy as well as recombinant adeno-associated virus (rAAV8)-mediated hAAT gene therapy significantly delayed onset and ameliorated disease development of arthritis in CIA mouse model. Importantly, hAAT therapies significantly reduced serum levels of BAFF and autoantibodies against bCII and mCII, suggesting that the effects are mediated via B-cells, at least partially.</p> <p>Conclusion</p> <p>These results present a new drug for arthritis therapy. Human AAT protein and gene therapies are able to ameliorate and delay arthritis development and reduce autoimmunity, indicating promising potential of these therapies as a new treatment strategy for RA.</p

High moon brightness and low ambient temperatures affect sloth predation by harpy eagles

Background: Climate plays a key role in the life histories of tropical vertebrates. However, tropical forests are only weakly seasonal compared with temperate and boreal regions. For species with limited ability to control core body temperature, even mild climatic variation can determine major behavioural outcomes, such as foraging and predator avoidance. In tropical forests, sloths are the arboreal vertebrate attaining the greatest biomass density, but their capacity to regulate body temperature is limited, relying on behavioural adaptations to thermoregulate. Sloths are largely or strictly nocturnal, and depend on crypsis to avoid predation. The harpy eagle (Harpia harpyja) is a sloth-specialist and exerts strong top-down control over its prey species. Yet the role of environmental variables on the regulation of predator-prey interactions between sloths and harpy eagles are unknown. The harpy eagle is considered Near Threatened. This motivated a comprehensive effort to reintroduce this species into parts of Mesoamerica. This effort incidentally enabled us to understand the prey profile of harpy eagles over multiple seasons. Methods: Our study was conducted between 2003 and 2009 at Soberanía National Park, Panamá. Telemetered harpy eagles were seen hunting and feeding on individual prey species. For each predation event, field assistants systematically recorded the species killed. We analysed the effects of climatic conditions and vegetation phenology on the prey species profile of harpy eagles using generalised linear mixed models. Results: Here we show that sloth predation by harpy eagles was negatively affected by nocturnal ambient light (i.e. bright moonshine) and positively affected by seasonally cool temperatures. We suggest that the first ensured low detectability conditions for sloths foraging at night and the second posed a thermally unsuitable climate that forced sloths to forage under riskier daylight. We showed that even moderate seasonal variation in temperature can influence the relationship between a keystone tropical forest predator and a dominant prey item. Therefore, predator-prey ecology in the tropics can be modulated by subtle changes in environmental conditions. The seasonal effects shown here suggest important demographic consequences for sloths, which are under top-down regulation from harpy eagle predation, perhaps limiting their geographic distribution at higher latitudes

Large-scale electron microscopy database for human type 1 diabetes

Autoimmune β-cell destruction leads to type 1 diabetes, but the pathophysiological mechanisms remain unclear. To help address this void, we created an open-access online repository, unprecedented in its size, composed of large-scale electron microscopy images ('nanotomy') of human pancreas tissue obtained from the Network for Pancreatic Organ donors with Diabetes (nPOD; www.nanotomy.org). Nanotomy allows analyses of complete donor islets with up to macromolecular resolution. Anomalies we found in type 1 diabetes included (i) an increase of 'intermediate cells' containing granules resembling those of exocrine zymogen and endocrine hormone secreting cells; and (ii) elevated presence of innate immune cells. These are our first results of mining the database and support recent findings that suggest that type 1 diabetes includes abnormalities in the exocrine pancreas that may induce endocrine cellular stress as a trigger for autoimmunity